The Board of Trustees of the University of Illinois

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Doing business as

Uic-MSHC James Jordan Family Life Center

Practice address

2102 W Monroe St
Chicago, IL 60612-3015

Phone

(312) 996-2000

Fax

(312) 413-1782

NPI assigned

Jul 14, 2006

Last updated

Aug 4, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOISAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Inn Lee

Title

Associate Director

Phone

(312) 413-9854

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• UIC-MSHC JAMES JORDAN FAMILY LIFE CENTER Doing business as

Part of

Uic Dept of Pathology

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1033135041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 W WASHINGTON BLVD",
            "address_2": "M/C 698",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122428",
            "telephone_number": "312-996-2000",
            "fax_number": "312-413-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 W MONROE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123015",
            "telephone_number": "312-996-2000",
            "fax_number": "312-413-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "INN",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "312-413-9854"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "1622185",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UIC-MSHC JAMES JORDAN FAMILY LIFE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• The Board of Trustees of the University of Illinois
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• The Board of Trustees of the University of Illinois (Occupational Health Service Institute (OHSI))
• The Board of Trustees of the University of Illinois (Hospital Psychiatric Unit)
• The Board of Trustees of the University of Illinois

• Federally Qualified Health Center (FQHC) in Chicago, IL
• Providers in Chicago, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.